Red Hands

What are Red hands?

The reddening of the palms without any known reason is called palmar erythema. The level of severity experienced depends upon the probable cause of the problem. The redness appears on the outer edges of the palm, the base of the thumb and the little finger. However, in some cases, the redness may spread to the fingers and the soles of the feet as well. Reddening of the soles of the feet is known as plantar erythema. Usually, liver diseases may change the hormonal balance leading to dilation of blood vessels which in turn results in palmar erythema.

Image Source: dermnetnz.org

Classification

Red hands can be a result of a variety of underlying health conditions and they are classified as follows:

• Primary Palmar erythema: The causes are either genetic or physiological. Primary palmar erythema is present at birth and remains throughout a person’s life. The person may not experience pain or inflammation and about 30% of women undergoing pregnancy experience reddening of their palms and other changes in their skin due to hormonal effects.
• Secondary Palmar erythema: The causes are usually related to some disease that results in redness of the palms. They include rheumatoid arthritis, diabetes mellitus, liver cirrhosis, hyperthyroidism, etc. Moreover, the use of medications such as topiramate, albuterol, cholestyramine, amiodarone, gemfibrozil, etc. also produces similar effects. Smoking and chronic mercury poisoning are among the environmental causes of secondary palmar erythema.

Red Hands Causes

• Heredity – People who belong to families where other members suffer from a condition of red hands can fall prey to the same problem. The genetic matter in their body can be responsible for the onset of palmar erythema.
• Liver disease – Liver diseases such as liver cirrhosis, hepatitis, hereditary hemochromatosis, etc. cause changes in hormonal balance, abnormal levels of estrogen & oestradiol and a dysfunction in arteriovenous anastomoses. Red palms can be a sign of liver diseases.
• Shoulder-hand syndrome – Reflex sympathetic dystrophy is another name for this syndrome that affects the upper extremities of the body. Pain and rigidity of the shoulder, hand and fingers are the characteristics of this condition. Red hands are one of the symptoms that accompany the shoulder-hand syndrome.
• Diabetes Mellitus – Diabetes mellitus is a condition in which the sugar or glucose level in the body is very high. The individual’s palms become red and hot. In some cases, red dots may be present instead of the palms becoming entirely red.
• Idiopathic causes – In cases where palmar erythema is an outcome of an unknown reason or in cases where the condition occurs in spite of the absence of identifiable triggers, the causes are known as idiopathic causes.
• Circulatory problems – Problems in blood circulation like polycythemia vera can cause redness of the palms. Dilating of the blood vessels under the skin may result in the skin becomes flushed and red.
• Rheumatological diseases – Rheumatoid arthritis and lupus erythematosus are health disorders that have red palms as a common symptom. Although people have not been able to establish a link between the appearance of red hands and rheumatoid arthritis, almost 60% of the people who have rheumatoid arthritis suffer from palmar erythema.
• Pregnancy – During pregnancy women have high estrogen levels that affect the circulatory system resulting in redness of the palms. Moreover, infection with syphilis virus during pregnancy can also cause redness of the palms as one of its symptoms.
• Sarcoidosis – Sarcoidosis is a multi-systemic inflammatory disease. Some symptoms appear due to this illness and palmar erythema is one of them.
• Cancer – Brain cancer, leukemia, liver cancer, ovarian cancer, metastases, etc. are all problems that account for growing tumors. In such cases, the estrogen levels are always higher than usual which results in red palms along with other symptoms.
• Thyroid problems – Increase in the level of estradiol results in the palms becoming red. Thyrotoxicosis and hyperthyroidism are some of the issues that have red hands as a symptom.
• Myelopathy – A degenerative condition which causes circulatory problems by pinching of the spinal cord is known as myelopathy. This state includes red palms along with other symptoms.
• Alcohol abuse and smoking – Excessive consumption of alcohol over an extended period damages the liver. As in the case of any liver disease, the levels of estrogen and oestradiol become abnormal and have an ill effect on health.

Smoking also causes problems in the circulatory system leading to palmar erythema.

Image Source: dermnetnz.org

Medications

Certain medicines are capable of promoting conditions of red hands due to the reaction of the substances in the body, they include:

• Gemfibrozil
• Albuterol
• Topiramate
• Amiodarone
• Cholestyramine Oral contraceptives

Chronic Mercury Intoxication – Cutaneous and neurological symptoms may appear due to chronic poisoning. These symptoms also include palms becoming red.

Red Hands Symptoms

• Reddish tinge of the palms
• No itchiness, pain or scaling
• Affected area of the skin is warm to touch
• The condition may be accompanied by red soles of the feet
• Redness may appear on the fingers and the thenar eminence
• The hypothenar eminence is the area of the palm that is affected
• Symmetrical reddening of the skin
• Discoloration of the palms and hand
• Blanching of the skin when pressure is applied on it
• Color may vary from red to vivid pink

Diagnosis

• Blood cell count
• Examination of blood sugar level
• Thyroid function
• Copper levels
• Iron levels
• Creatinine levels
• Rheumatoid factor levels
• Blood urea nitrogen
• CT Scan
• Tests for the presence of antibodies
• MRI
• Bone marrow biopsy

Treatment

Medications

Doctors often prescribe any of the following medications depending on the severity of the issue to treat red hands. It is strictly advised to consult a doctor before consuming any of the medicines mentioned below:

• Venlafaxine (Effexor XR)
• Duloxetine (Cymbalta)
• Gabapentin (Neurontin)
• Pregabalin (Lyrica)
• Desipramine (Norpramin)
• Topiramate (Topamax)
• Amitryptaline (Elavil)
• Carbamazepine (Tegretol)

Over the Counter Medication

• Motrin IB
• Advil
• Aleve
• Tramadol (Ultram)
• Miconazole (Micatin)
• Terbinafine (Lamisil AT)
• Fluconazole (Diflucan)
• Tylenol
• Naftifine (Naftin)
• Itraconazole (Sporanox)

Other Treatments

• Plasma Exchange (plasmapheresis)
• People must reduce the use of alcohol considerably. Medical help should be taken if the symptoms persist for a long time.
• Oral administration or injection of the nutrient vitamin B12 must be given to make up for its deficiency
• Immune Globulin Therapy (IVIG)
• Kidney problems must be treated with dialysis to avoid side effects like redness and burning of the palms and hands
• Oral medication can be given to individuals to raise the thyroid levels in their hormones

Palmar Erythema (Red on Hands) pictures:

Palmar Erythema photo. Image Source: dermnetnz.org Image Source: dermnetnz.org Image Source: dermnetnz.org